Newborn Syphilis – What’s New, What Isn’t

It seems as if every time we read the news, a new germ is in the headlines. However, there are still plenty of organisms to worry about that have been around for quite some time. One, in particular, was first identified in 1905, though the disease it causes has been known since at least the 15th century. It’s preventable. It’s easily tested for and, in the great majority of people, easily treated. But if untreated, it can cause devastating, often fatal disease that’s right up there with the worst of the “new” infections making the news these days.

We are, of course, talking about syphilis. One reason it’s important to talk about it is that it’s on the rise. And we talk a lot about it here because it can be devastating if an infant acquires Treponema pallidum—the germ, or spirochete, known to cause syphilis.

Congenital Syphilis Revisited

I discussed congenital syphilis (syphilis transmitted from mother to baby) in a previous blog, but since we continue to see more and more of it in pediatrics, the basics are worth summarizing here. The syphilis germ is transmitted from person to person through intimate sexual contact. Although there is sometimes a sore, or chancre, present where the germ entered, it may go unnoticed. Any other early symptoms may just look like a viral bug, or there may be no symptoms.

More serious symptoms may occur years down the road in adults who contact the germ. But an unborn baby who acquires the spirochete from its mother can have problems much sooner. Up to 40 percent of newborns who contract syphilis during Mom’s pregnancy die either before birth or shortly afterward. Those who don’t may have damage to any number of their vital organs, including liver, lungs, bones, brain and nerves. Even infected newborns who are well at birth—many of whom acquired the germ late in Mom’s pregnancy—may contract serious problems if untreated.

What’s Behind the Rise in Cases?

It’s hard to believe that just a few decades ago, we were thinking that the total elimination of syphilis worldwide was within reach. In recent years, however, that goal has been put on hold due to the increase in the number of cases. Two years ago, a blog described this rising tide; since that time, the news has only gotten worse. In a recent report, the Centers for Disease Control and Prevention found that the incidence of early syphilis in women increased by 21.1 percent between 2016 and 2017 alone. The rate among women has more than doubled since 2013. All this has amounted to a rate of congenital syphilis that has also more than doubled in that time, and increased 43.8 percent from 2016 to 2017.

So…why this rise in this era of health care advances? Various factors have been noted. Worldwide, there has been a shift from rural to urban living, especially in what had been considered developing countries. Travel opportunities for all are greater, allowing people from low-risk areas to visit high-risk areas and vice versa. And technology has allowed people to, well, meet readily. Finally, limitations have been put on access to health care, especially free or low-cost STD testing and treatment centers.

What It All Means, and What to Do

These statistics may seem scary, and they are. But it’s important to remember that syphilis, particularly in the early stages, is a very treatable disease. Although many germs in recent years have become resistant to various antibiotics, that is fortunately not the case with syphilis-causing Trepomena pallidum, and the tried-and-true antibiotic penicillin still works in almost all cases.

However, your provider has to find the infection first in order to treat it. This is yet another reason to get in early for prenatal care. Obstetric providers will usually test for the infection early, and will often do a second test later in pregnancy. In the unlikely event that the test isn’t done or the result isn’t known to you, don’t hesitate to ask for it. And don’t be afraid to share any concerns you might have about your (or your partner’s) risk for the disease. Your baby’s health is important, and in 2019 and beyond, no infant should have to suffer from congenital syphilis.

Dr. Stan Sack has 29 years’ experience as a primary care pediatrician in Massachusetts and Florida. A medical writer since 2015, he enjoys blogging on topics that are on parents’ minds but are covered less often in books and on websites. He lives in the Florida Keys with his family and enjoys healthy cooking, fitness activities and singing in his spare time.